05D0930388 CLIA NUMBER - SANTA ROSA DE LIMA MEDICAL CLINIC INC

Laboratory Demographics

CLIA Number: 05D0930388

Facility Name: SANTA ROSA DE LIMA MEDICAL CLINIC INC

Facility Address:
6915 SEVILLE AVE
HUNTINGTON PARK, CA
ZIP 90255
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Facility Phone Number: 213 588-9800

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1821139205

Taxonomy: 208D00000X - General Practice
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee

CLIA Record

Field Name	Field Value
CLIA Number	05D0930388
LAB Type	Physician Office
Facility Name	SANTA ROSA DE LIMA MEDICAL CLINIC INC
Street	6915 SEVILLE AVE
City	HUNTINGTON PARK
State	CA
ZIP	90255
Phone	213 588-9800
CertificateType	4
CertificateEffectiveDate	7/15/2023
CertificateExpirationDate	7/14/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024